Layering Treatment for High-Risk Primary Prevention

A 65-year-old black woman with a history of hypertension, high cholesterol and diabetes mellitus is seen in follow up. She is currently on hydrochlorothiazide 25 mg daily, amlodipine 5 mg daily, lisinopril 20 mg daily, rosuvastatin 20 mg daily, and metformin 1000 mg bid.

Her blood pressure in clinic is 130/80 mm Hg, her BMI is 31 kg/m2 and her waist is 40 inches.

Recent labs show: total cholesterol 159 mg/dL, LDL-C 75 mg/dL, triglycerides 220 mg/dL, HDL-C 40 mg/dL, Hba1c 6.8%, and creatinine 1.3 mg/dL.

Her 10-year atherosclerotic cardiovascular disease [ASCVD] risk is calculated at 18.7%

Which of the following should be done at this time to reduce her risk for future cardiovascular events?

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